Bernadette10
Guru
Does anyone have experience with this? 54505 and 53899, or 54865? Thanks for any advice.
Diagnosis: Azoospermia
Operation: Right percutaneous epididymal aspiration, left epididymal aspiration, bilateral testicular sperm extraction
Anesthesia: MAC
Pathology: None
Findings: Borderline testicular size, right percutaneous epididymal aspiration with no obvious sperm, right testicular biopsy likewise with what appeared to be atrophic tubules and no obvious sperm, left testicle delivered, direct aspirate of dilated tubules within the tail of the epididymis with no obvious sperm, left testicular biopsy additionally performed, sample was given to his wife to deliver immediately postoperatively to the fertility lab
This is a 45 y.o. male with history of vasectomy 10yrs ago and desire for future fertility. Discussed various reproductive options and elected to proceed with epididymal sperm aspiration and possible testicular biopsy bilaterally, preferred in the OR. We reviewed risks per consent and mutually signed.
The testicles were palpated, borderline size bilaterally, felt to be slightly more full on the right. A right spermatic cord block was performed with injection of 1% lidocaine/0.5% Marcaine into the cord just adjacent to the base of the penis. While securing the epididymal head, the overlying skin was anesthetized with local anesthetic as well. A 21-gauge butterfly needle was then passed directly into the head of the epididymis and continuous suction used to aspirate an epididymal sample. The needle was repassed into various positions within the epididymis and then removed. A wet prep slide was made, and back table benchtop microscopy demonstrated no obvious sperm. The epididymal aspirate was placed in sperm buffer with an eppendorf tube. We therefore decided to proceed with a right testicular biopsy.
While elevating the right testis, the overlying skin was anesthetized. A 2.5 centimeter incision was then made and dissection carried down with electrocautery until the tunica vaginalis was opened. A securing 4-0 Vicryl suture was passed through the visualized tunica albuginea and a 1 cm incision then made in the tunica until seminiferous tubules were noted to extrude. The extruding tubules were then cut with scissors and placed in sperm buffer. Hemostasis was achieved with electrocautery and the tunica albuginea closed with the 4-0 Vicryl suture previously placed. Incision was then closed in layers with 4-0 Vicryl in the tunica vaginalis followed by dartos. Skin was closed with running 4-0 Monocryl suture.
Given no obvious sperm seen on the right side, the same procedure was performed on the left side.
Diagnosis: Azoospermia
Operation: Right percutaneous epididymal aspiration, left epididymal aspiration, bilateral testicular sperm extraction
Anesthesia: MAC
Pathology: None
Findings: Borderline testicular size, right percutaneous epididymal aspiration with no obvious sperm, right testicular biopsy likewise with what appeared to be atrophic tubules and no obvious sperm, left testicle delivered, direct aspirate of dilated tubules within the tail of the epididymis with no obvious sperm, left testicular biopsy additionally performed, sample was given to his wife to deliver immediately postoperatively to the fertility lab
This is a 45 y.o. male with history of vasectomy 10yrs ago and desire for future fertility. Discussed various reproductive options and elected to proceed with epididymal sperm aspiration and possible testicular biopsy bilaterally, preferred in the OR. We reviewed risks per consent and mutually signed.
The testicles were palpated, borderline size bilaterally, felt to be slightly more full on the right. A right spermatic cord block was performed with injection of 1% lidocaine/0.5% Marcaine into the cord just adjacent to the base of the penis. While securing the epididymal head, the overlying skin was anesthetized with local anesthetic as well. A 21-gauge butterfly needle was then passed directly into the head of the epididymis and continuous suction used to aspirate an epididymal sample. The needle was repassed into various positions within the epididymis and then removed. A wet prep slide was made, and back table benchtop microscopy demonstrated no obvious sperm. The epididymal aspirate was placed in sperm buffer with an eppendorf tube. We therefore decided to proceed with a right testicular biopsy.
While elevating the right testis, the overlying skin was anesthetized. A 2.5 centimeter incision was then made and dissection carried down with electrocautery until the tunica vaginalis was opened. A securing 4-0 Vicryl suture was passed through the visualized tunica albuginea and a 1 cm incision then made in the tunica until seminiferous tubules were noted to extrude. The extruding tubules were then cut with scissors and placed in sperm buffer. Hemostasis was achieved with electrocautery and the tunica albuginea closed with the 4-0 Vicryl suture previously placed. Incision was then closed in layers with 4-0 Vicryl in the tunica vaginalis followed by dartos. Skin was closed with running 4-0 Monocryl suture.
Given no obvious sperm seen on the right side, the same procedure was performed on the left side.